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The 8 differences between psychotic and dissociative disorders

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Do you know what are the main characteristics of psychotic disorders? And of the dissociatives? In this article, in addition to responding to it, we will know the main differences between psychotic and dissociative disorders.

As we will see, these are two completely different types of mental disorders, and we will verify this from their characterization and the development of their corresponding differences.

  • Related article: "The 16 most common mental disorders"

Psychotic and dissociative disorders: what are they like?

Before delving into the differences between psychotic and dissociative disorders, let's see what each of them consists of (and what they are).

1. Psychotic disorders

Psychotic disorders are a type of serious mental disorder, in which strange or abnormal ideas and perceptions appear. There is also usually a loss of contact with reality; the psychotic symptoms "par excellence" are hallucinations and delusions, although there are more.

The DSM-5 (Statistical Manual of Mental Disorders) collects the following psychotic disorders:

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  • Schizophrenia
  • Brief psychotic disorder
  • Schizophreniform disorder
  • Delusional disorder
  • Schizoaffective disorder
  • Psychotic disorder due to other medical conditions
  • Substance-Induced Psychotic Disorder
  • Catatonia
  • Other specified schizophrenia spectrum disorders
  • Other unspecified schizophrenia spectrum disorders

2. Dissociative disorders

For their part, dissociative disorders are those in which there is a loss of integrative functions of memory, identity, perception, motor functions, or consciousness.

Its characteristic symptom is an alteration in the organization or structure of the mental content (not so much an alteration of the content itself). Thus, there is a disconnection and a lack of continuity between memories, thoughts, actions, identity ...

It is worth mentioning that dissociative phenomena need not always be pathological; there are dissociative phenomena that are not.

In DSM-5 we find the following dissociative disorders:

  • Dissociative identity disorder
  • Dissociative amnesia
  • Depersonalization Disorder /derealization
  • Other specified dissociative disorder
  • Dissociative disorder, unspecified

The most important differences between psychotic and dissociative disorders

In this article we have collected the 8 main differences between psychotic and dissociative disorders, although there are more.

1. Main symptoms

The first of the differences between psychotic and dissociative disorders are their symptoms; As we have seen, these are two types of independent and differentiated disorders, each with its own characteristics.

In psychotic disorders the main problem is one or more psychotic symptoms that involve a distorted perception of the present (hallucinations, delusions, disorganized thinking ...); In contrast, in dissociative disorders, there are no psychotic symptoms, but their main symptom it is a discontinuity (or interruption) between our identity, our memory, our behavior, etc.

So, as we see, the main symptoms in both disorders are totally different.

2. Nature of symptoms

The nature of the symptoms is also diverse. Thus, psychotic disorders involve the appearance of one or more symptoms (psychotic), establishing an incongruity between what the senses capture and what the consciousness perceives; instead, in dissociative disorders, there is a loss of a function (memory, identity ...) that functions in a limited way.

3. Contact with reality / awareness of the disorder

Another difference between psychotic and dissociative disorders has to do with contact with reality.

In psychotic disorders (for example schizophrenia) there is usually a loss of contact with immediate reality; on the other hand, not in dissociative disorders.

Furthermore, in psychotic disorders it is more common for the person to be unaware of their involvement; instead, in dissociative disorders, people are often aware of their "losses". For example, this is clearly seen in the dissociative amnesia, where there is significant autobiographical memory loss.

4. Presence of cognitive disorders

In psychotic disorders cognitive disorders or alterations may appear (and they frequently appear), which usually affect attention, memory, decision-making, planning... These symptoms appear, above all, in advanced stages of the disorder (especially in schizophrenia).

In contrast, in dissociative disorders these symptoms are not characteristic (except for the loss of memory that occurs in dissociative amnesia or dissociative fugue, although it would be different nature).

5. Duration

We must be cautious in this regard, since there are different disorders within the psychotic and within the dissociative, and each has its own characteristics. However, the truth is that we can say that duration is another difference between psychotic and dissociative disorders.

In general, psychotic disorders tend to last longer (Some are even chronic disorders), while dissociative disorders usually have a beginning and an end, that is, a shorter duration, limited in time (days, months ...). Furthermore, in the case of non-chronic psychotic disorders (for example, brief psychotic disorder), the duration of the disorders is usually longer than the duration of the dissociative disorders.

But let's give examples. In the case of psychotic disorders, Let's think about schizophrenia; this is chronic. On the other hand, if we think about substance-induced psychotic disorders, they are temporary and therefore its duration is shorter (also schizophreniform disorder, which lasts between one month and six months).

In the case of dissociative disorders, consider dissociative fugue or dissociative (psychogenic) amnesia; Both disorders usually last between hours and months (more hours than months).

6. Degree of incapacitation

Another difference between psychotic and dissociative disorders is their degree of interference in daily life or life. incapacitation that it produces (remember that we always speak at a general level, and that each disorder must always be analyzed in a specific). Psychotic disorders are typically more disabling than dissociative disorders..

7. Prevalence

The prevalence of psychotic disorders in general is not known exactly, but it is we know its prevalence in the case of schizophrenia (0.3-0-7% of the population, according to DSM-5) or schizoaffective disorder (0.3% according to DSM-5).

For its part, dissociation is estimated to occur in 2-3% of the general population, while dissociative disorders themselves, according to some studies (Loewenstein, 1994) have a prevalence of 10% in the population.

8. Causes

Another difference between psychotic and dissociative disorders has to do with their causes.

The causes of psychotic disorders are usually multifactorial (less in those induced by substances or by other medical conditions). Thus, social, biological and environmental factors are combined in its etiology, although it is worth highlighting the hereditary factor in disorders psychotic (especially in schizophrenia, where monozygotic twins are known to have a 48% chance of suffering from it both of them).

In the case of dissociative disorders, we also find multifactorial causes, although it is true that psychological trauma is usually at its base frequently (sexual or physical abuse in childhood, witnessing or experiencing an accident, events where death is witnessed, etc.).

Psychotic disorders usually appear, rather than as a result of trauma, as a result of a highly stressful, which adds other etiological factors (biological or personal vulnerability, inheritance biological…). In contrast, dissociative disorders usually appear as a result of a trauma or a situation that the person feels as highly threatening or dangerous for them.

Bibliographic references:

  • American Psychiatric Association -APA- (2014). DSM-5. Diagnostic and Statistical Manual of Mental Disorders. Madrid: Panamericana.
  • Barrera, A. (2006). The cognitive disorders of schizophrenia. Chilean journal of neuro-psychiatry, 44 (3): 215-221.
  • Belloch, A., Sandín, B. and Ramos, F. (2010). Manual of Psychopathology. Volume I and II. Madrid: McGraw-Hill.
  • Jongsma, H.E, et al. (2018). Treated Incidence of Psychotic Disorders in the Multinational EU-GEI Study. JAMA Psychiatry, 75 (1): 36-46.
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